CCMA Administrative Assistance Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Easy

   What is the purpose of establishing the appointment matrix?

   1. AA. To list patients who missed appointments
   2. BB. To track insurance payments by date
   3. CC. To block off unavailable times
   4. DD. To record the reasons for each visit
   Show answer to question 1

   Answer: C. To block off unavailable times

   Establishing the matrix means blocking out times when providers are not available, such as meetings, hospital rounds, lunch or vacation, before appointments are booked. This prevents patients from being scheduled when no one can see them.

   Why the other options are wrong

   • AMissed appointments are documented in the patient's record and tracking reports.
   • BPayment tracking is a billing function, not part of the schedule matrix.
   • DVisit reasons are recorded when each appointment is booked.

2. Question 2 of 25Easy

   What is a clean claim?

   1. AA. A claim that was paid in full by the patient
   2. BB. An error-free claim ready for processing
   3. CC. A claim submitted on paper rather than electronically
   4. DD. A claim for a patient with no other insurance
   Show answer to question 2

   Answer: B. An error-free claim ready for processing

   A clean claim has complete, accurate information and no errors, so the payer can process it without asking for more information. Clean claims are paid faster.

   Why the other options are wrong

   • APatient payment does not make a claim clean.
   • CClaims can be clean whether submitted on paper or electronically.
   • DHaving only one insurance plan does not make a claim error-free.

3. Question 3 of 25Medium

   A practice leaves a large part of each day unbooked so patients who call that morning can be seen the same day. Which scheduling method is this?

   1. AA. Cluster scheduling
   2. BB. Modified wave
   3. CC. Stream scheduling
   4. DD. Open access scheduling
   Show answer to question 3

   Answer: D. Open access scheduling

   Open access, or advanced access, scheduling holds much of the day for same-day appointments. It improves access but requires careful planning for busy days.

   Why the other options are wrong

   • ACluster scheduling groups similar types of visits together.
   • BA modified wave books several patients early in each hour and others later in the hour.
   • CStream scheduling books patients at regular, fixed intervals in advance.

4. Question 4 of 25Hard

   A patient enrolled in a Preferred Provider Organization (PPO) elects to see a non-participating specialist for a non-emergent consultation without obtaining a referral. What will most likely happen to the claim?

   1. AA. The insurer will deny the claim because a primary care referral is required before consulting any specialist.
   2. BB. The insurer will deny the claim entirely because out-of-network care is excluded from PPO plans.
   3. CC. The insurer will process the claim, but the patient will be responsible for a higher coinsurance rate and deductible.
   4. DD. The insurer will pay the specialist the full billed charge with no patient financial responsibility.
   Show answer to question 4

   Answer: C. The insurer will process the claim, but the patient will be responsible for a higher coinsurance rate and deductible.

   PPO plans allow members to seek care outside the preferred network without a referral, but they impose higher deductibles, copayments, or coinsurance rates for out-of-network services. Complete denial for seeking out-of-network care without an emergency is characteristic of closed-panel HMOs and EPOs, not PPOs. PPO members retain the flexibility to see non-participating providers at increased out-of-pocket expense.

5. Question 5 of 25Easy

   What is a practice's fee schedule?

   1. AA. A list of the practice's charges for services
   2. BB. A calendar showing when patients' bills are due
   3. CC. A list of each staff member's hourly pay rate
   4. DD. A schedule of the provider's available appointments
   Show answer to question 5

   Answer: A. A list of the practice's charges for services

   A fee schedule lists the practice's standard charges for each service or procedure, usually by code. Payers may have their own fee schedules that set allowed amounts.

   Why the other options are wrong

   • BBilling due dates are set by account policies, not the fee schedule.
   • CStaff pay rates are payroll information.
   • DProvider availability is shown in the appointment schedule.

6. Question 6 of 25Hard

   An uninsured patient calls to schedule a nonurgent procedure and says she will pay for it herself. Under the federal No Surprises Act, what must the office provide?

   1. AA. A signed Advance Beneficiary Notice
   2. BB. A good faith estimate of charges
   3. CC. A referral authorization number
   4. DD. An explanation of benefits
   Show answer to question 6

   Answer: B. A good faith estimate of charges

   Under the No Surprises Act, providers must give uninsured or self-pay patients a good faith estimate of expected charges for scheduled services or on request. It helps patients understand costs before care.

   Why the other options are wrong

   • AAn ABN is used for patients with Original Medicare when a service may not be covered.
   • CReferral authorizations come from insurance plans, which this patient does not use.
   • DAn explanation of benefits is issued by an insurer after a claim is processed.

7. Question 7 of 25Hard

   A provider orders an outpatient MRI. The patient's plan requires prior authorization for advanced imaging. What should happen before the MRI is performed?

   1. AA. Get the plan's approval and record the number
   2. BB. Schedule the MRI and submit the request after it is done
   3. CC. Have the patient sign a waiver so the plan must pay
   4. DD. Ask the imaging center to decide whether approval is needed
   Show answer to question 7

   Answer: A. Get the plan's approval and record the number

   Prior authorization is approval from the insurance plan before certain services are performed. The office submits the request with supporting information and records the authorization number; without it, the claim may be denied.

   Why the other options are wrong

   • BAuthorization must be obtained before the service; requests made afterward are often denied.
   • CA patient waiver cannot force an insurance plan to pay.
   • DThe ordering office is responsible for knowing the plan's requirements and obtaining approval.

8. Question 8 of 25Medium

   According to the Office of Inspector General (OIG) compliance guidelines for individual and small group practices, which action is recognized as a fundamental element of a compliance program?

   1. AA. Using duplicate data entry for all commercial insurance claims
   2. BB. Reporting every internal coding mistake directly to the OIG
   3. CC. Conducting ongoing internal monitoring and periodic audits
   4. DD. Maintaining clinical encounter records indefinitely without archiving
   Show answer to question 8

   Answer: C. Conducting ongoing internal monitoring and periodic audits

   The OIG outlines seven core elements of an effective compliance plan, which include conducting internal monitoring and regular auditing to uncover noncompliant billing practices. Self-reporting minor internal billing errors directly to federal investigators is not a standard requirement, as normal errors should be resolved through internal correction and payer refunds. Duplicate entry is inefficient and not an OIG guideline, and record retention guidelines vary by state and federal rules rather than requiring indefinite active storage.

9. Question 9 of 25Hard

   The office's EHR system goes down unexpectedly during a busy morning, and patients are still being seen. What should the medical assistant do, following the downtime procedure?

   1. AA. Stop seeing patients until the system is restored
   2. BB. Keep notes on personal phones and email them later
   3. CC. Use the approved paper forms and enter data later
   4. DD. Skip documentation for visits during the outage
   Show answer to question 9

   Answer: C. Use the approved paper forms and enter data later

   Downtime procedures use approved paper forms to document care during an outage. Once the system is restored, the information is entered or scanned into the EHR so the record is complete.

   Why the other options are wrong

   • ACare can usually continue safely using downtime procedures.
   • BPersonal phones and email are not secure for patient information.
   • DAll care must be documented, even when the EHR is unavailable.

10. Question 10 of 25Medium

    A shipment of exam gloves and syringes arrives at the office. What should the medical assistant do first?

    1. AA. Put the items away and recycle the box
    2. BB. Compare the packing slip with the order and contents
    3. CC. Pay the invoice right away before checking anything
    4. DD. Return the shipment unopened to be safe
    Show answer to question 10

    Answer: B. Compare the packing slip with the order and contents

    When supplies arrive, the packing slip is compared with the purchase order and the actual contents to confirm items, quantities and condition. Discrepancies are noted and reported before the invoice is paid.

    Why the other options are wrong

    • APutting items away without checking can miss shortages or damaged goods.
    • CPaying before verifying the shipment can mean paying for missing items.
    • DReturning an expected shipment without checking it delays needed supplies.

11. Question 11 of 25Medium

    A new patient is scheduled for next week. What is the main reason the medical assistant verifies insurance eligibility before the appointment?

    1. AA. To decide which provider the patient should see
    2. BB. To confirm the patient's diagnosis in advance
    3. CC. To find out the patient's employer and salary
    4. DD. To confirm active coverage and patient costs
    Show answer to question 11

    Answer: D. To confirm active coverage and patient costs

    Verifying eligibility before the visit confirms that coverage is active and identifies copays, deductibles and any referral or authorization requirements. This prevents denials and lets the office tell the patient about expected costs.

    Why the other options are wrong

    • AProvider assignment is not determined by eligibility verification.
    • BDiagnoses are made by the provider during the visit.
    • CSalary information is not needed and is not part of eligibility verification.

12. Question 12 of 25Medium

    A patient has met her annual deductible. Her plan pays 80% of the allowed amount, and she pays 20% coinsurance. The allowed amount for today's service is $200. How much does she owe?

    1. AA. $160
    2. BB. $20
    3. CC. $200
    4. DD. $40
    Show answer to question 12

    Answer: D. $40

    Coinsurance is the patient's percentage share of the allowed amount after the deductible is met. Twenty percent of $200 is $40, and the plan pays the remaining $160.

    Why the other options are wrong

    • A$160 is the plan's 80% share, not the patient's.
    • B$20 would be 10% of the allowed amount.
    • C$200 is the full allowed amount, which she would owe only if her deductible were not met.

13. Question 13 of 25Easy

    Which action should a medical assistant take first prior to faxing sensitive protected health information to an outside consulting physician?

    1. AA. Verify the recipient's fax number by telephone
    2. BB. File an incident disclosure report with the compliance officer
    3. CC. Remove all identifying demographic data from the record
    4. DD. Obtain written authorization from the consulting specialist
    Show answer to question 13

    Answer: A. Verify the recipient's fax number by telephone

    Verifying the accuracy of the recipient's fax number before sending protected health information is a primary administrative safeguard to prevent unauthorized disclosure. Removing demographic data is incorrect because the consulting specialist requires patient identifiers to properly review the records and provide care.

14. Question 14 of 25Medium

    A centrifuge starts making a loud grinding noise and shaking during a run. After it stops, what should the medical assistant do?

    1. AA. Tag it out of service and report it
    2. BB. Keep using it, since it finished the run
    3. CC. Try fixing it by tightening parts inside the rotor
    4. DD. Unplug it and wait to report it until it fails again
    Show answer to question 14

    Answer: A. Tag it out of service and report it

    Malfunctioning equipment is removed from use, labeled out of service and reported according to policy so it can be repaired. The problem and the repair are recorded in the equipment maintenance log.

    Why the other options are wrong

    • BContinuing to use faulty equipment risks injury and inaccurate results.
    • CRepairs should be made by qualified service personnel, not by staff opening the rotor.
    • DWaiting to report the problem puts other staff and patients at risk.

15. Question 15 of 25Easy

    What is an electronic remittance advice (ERA)?

    1. AA. A request for prior authorization sent online
    2. BB. A reminder message sent to patients by text
    3. CC. An electronic claim sent from the office to a payer
    4. DD. An electronic statement of claim payments
    Show answer to question 15

    Answer: D. An electronic statement of claim payments

    An electronic remittance advice is the payer's electronic statement of how claims were processed, including payments, adjustments and denial reasons. It replaces paper remittance notices for the office.

    Why the other options are wrong

    • APrior authorization requests are separate transactions.
    • BPatient text reminders are not remittance documents.
    • CThe claim goes from the office to the payer; the ERA comes back from the payer.

16. Question 16 of 25Medium

    An established patient checks in for a follow-up visit. What should the medical assistant do with her insurance information?

    1. AA. Ask whether it changed and verify the current card
    2. BB. Skip it, since it was verified at her first visit
    3. CC. Copy last year's card information into today's claim
    4. DD. Ask her to verify her own coverage after the visit
    Show answer to question 16

    Answer: A. Ask whether it changed and verify the current card

    Insurance coverage can change at any time, so the medical assistant asks about changes and verifies the current card, front and back, at each visit. This prevents claim denials and billing problems.

    Why the other options are wrong

    • BCoverage verified at a past visit may no longer be active.
    • CUsing outdated information can lead to denied claims.
    • DVerifying coverage is the office's responsibility and should happen before services are provided.

17. Question 17 of 25Hard

    A claim for an EKG is denied for lack of medical necessity. The only diagnosis code on the claim is for a sprained ankle. What is the most likely problem?

    1. AA. The diagnosis does not justify the EKG
    2. BB. The EKG was billed under the wrong patient's name
    3. CC. The claim was submitted after the filing deadline
    4. DD. The patient did not pay the copayment that day
    Show answer to question 17

    Answer: A. The diagnosis does not justify the EKG

    Medical necessity means the diagnosis on the claim must support the service billed. An ankle sprain does not explain why an EKG was needed, so the payer denied it; the documented reason for the EKG should be coded if the record supports it.

    Why the other options are wrong

    • BA wrong patient name would cause a rejection for identification errors, not a medical necessity denial.
    • CA late claim is denied for timely filing, not for lack of medical necessity.
    • DAn unpaid copay does not cause a medical necessity denial.

18. Question 18 of 25Hard

    A patient has missed three scheduled appointments in four months without calling. What should the medical assistant do, according to office policy?

    1. AA. Remove the patient from the practice immediately
    2. BB. Refuse to schedule any more visits for the patient
    3. CC. Erase the missed visits so the record looks clean
    4. DD. Document each no-show and notify the provider
    Show answer to question 18

    Answer: D. Document each no-show and notify the provider

    Each missed appointment is documented in the patient's record, and repeated no-shows are brought to the provider's attention. Any decision to dismiss a patient belongs to the provider and requires written notice under office policy.

    Why the other options are wrong

    • AA medical assistant cannot dismiss a patient; dismissal must follow a formal process to avoid abandonment.
    • BRefusing all future care without the provider's decision and proper notice is inappropriate.
    • CMissed appointments must remain in the record because they may matter legally and clinically.

19. Question 19 of 25Easy

    When is a patient's copayment usually collected in a medical office?

    1. AA. After the insurance claim is paid
    2. BB. At the time of service
    3. CC. Only at the end of the calendar year
    4. DD. When the patient receives a statement
    Show answer to question 19

    Answer: B. At the time of service

    A copayment is a fixed amount the patient pays for a covered service, and offices usually collect it at the time of service, often at check-in. This improves cash flow and reduces billing costs.

    Why the other options are wrong

    • AThe copay amount is known in advance, so offices do not wait for claim payment.
    • CWaiting until year-end delays payment and is not standard practice.
    • DSending statements for copays adds cost and delays collection.

20. Question 20 of 25Hard

    A medical assistant realizes she entered the wrong blood pressure in a patient's electronic health record earlier today. How should she correct it?

    1. AA. Delete the entry and enter the correct reading
    2. BB. Amend it, keeping the original visible in the record
    3. CC. Ask the IT staff to erase the entry from the system
    4. DD. Leave it, since EHR entries cannot be corrected
    Show answer to question 20

    Answer: B. Amend it, keeping the original visible in the record

    EHR errors are corrected with the system's amendment or correction function, which keeps the original entry and records the correction with the date, time, user and often a reason. The audit trail shows who made the change.

    Why the other options are wrong

    • ADeleting an entry hides the original information and can look like tampering.
    • CErasing entries is improper and undermines the record's legal integrity.
    • DEHR entries can and should be corrected through the proper process.

21. Question 21 of 25Medium

    A patient in an HMO plan wants to see a dermatologist. What does the HMO plan usually require?

    1. AA. No referral, as long as the dermatologist is out of network
    2. BB. Payment in full by the patient, with later reimbursement
    3. CC. A signed Advance Beneficiary Notice before every visit
    4. DD. A PCP referral to an in-network specialist
    Show answer to question 21

    Answer: D. A PCP referral to an in-network specialist

    HMO plans usually require members to choose a primary care provider (PCP), who acts as a gatekeeper and refers the member to in-network specialists. Without the referral, the plan may not pay.

    Why the other options are wrong

    • AHMOs generally do not cover out-of-network care except in emergencies.
    • BHMO members pay copays for covered services; they are not usually reimbursed later.
    • CAdvance Beneficiary Notices apply to Original Medicare, not to specialist referrals in an HMO.

22. Question 22 of 25Easy

    Which health care program covers active-duty service members, military retirees and their eligible family members?

    1. AA. Medicaid
    2. BB. CHAMPVA
    3. CC. TRICARE
    4. DD. Medicare Part A
    Show answer to question 22

    Answer: C. TRICARE

    TRICARE is the Department of Defense health care program for active-duty and retired uniformed service members and their eligible family members.

    Why the other options are wrong

    • AMedicaid is a joint federal and state program based mainly on income and need.
    • BCHAMPVA covers certain family members of disabled or deceased veterans who are not eligible for TRICARE.
    • DMedicare Part A covers inpatient hospital care for Medicare beneficiaries.

23. Question 23 of 25Medium

    What is the purpose of a modifier added to a CPT code?

    1. AA. To replace the diagnosis code on the claim
    2. BB. To show the patient's insurance group number
    3. CC. To indicate that a service was altered
    4. DD. To list the drugs given during the visit
    Show answer to question 23

    Answer: C. To indicate that a service was altered

    Modifiers are two-character codes added to a procedure code to show that a service was altered by specific circumstances, such as a bilateral procedure or a separate service on the same day, without changing the code's definition.

    Why the other options are wrong

    • AModifiers do not replace diagnosis codes; both are needed on the claim.
    • BGroup numbers are insurance identifiers, not coding modifiers.
    • DDrugs are reported with their own codes, not with modifiers.

24. Question 24 of 25Medium

    A provider wants a patient's fasting lab results available at a follow-up visit in three weeks. How should the medical assistant schedule the lab draw?

    1. AA. On the morning of the follow-up visit, right before it
    2. BB. Several days before the follow-up visit
    3. CC. The week after the follow-up visit
    4. DD. Whenever the patient has time this year
    Show answer to question 24

    Answer: B. Several days before the follow-up visit

    Scheduling the lab draw a few days before the follow-up allows time for results to be reported and reviewed, so the provider can discuss them at the visit.

    Why the other options are wrong

    • AResults drawn right before the visit may not be ready in time.
    • CTesting after the visit means the results cannot be discussed at that appointment.
    • DAn open timeline risks the results being missing at the follow-up visit.

25. Question 25 of 25Medium

    A patient says she receives her Medicare benefits through a plan run by a private insurance company that combines her hospital and medical coverage. Which part of Medicare is this?

    1. AA. Part C
    2. BB. Part A
    3. CC. Part B
    4. DD. Part D
    Show answer to question 25

    Answer: A. Part C

    Medicare Part C, called Medicare Advantage, lets beneficiaries receive their Part A and Part B benefits through approved private plans, which often include drug coverage. The office bills the Medicare Advantage plan rather than Original Medicare.

    Why the other options are wrong

    • BPart A is the hospital insurance part of Original Medicare, not a private plan.
    • CPart B is the medical insurance part of Original Medicare, not a private plan.
    • DPart D covers prescription drugs only and does not combine hospital and medical coverage.

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